Jacques wrote:I think that the best way to help your brother with the second-opinion issue is for you to use your excellent writing skills to help him draft a concise and convincing letter (i.e., "Re: Second-opinion request") to accompany his submitted medical file.
This would require some serious thought about what he can realistically request, given his current diagnosis and the (probably incomplete) state of his current medical file.
In my opinion, the world-class experts at the second-opinion hospital are not going to want to seriously consider a medical file that is incomplete or carelessly prepared. It's not worth their while to try to second-guess the patient's situation in the absence of informaton that they deem critical for a proper analysis.
Thus, I think that the first contact with a potential second-opinion hospital would be to ask them what exactly they will need to have in the submitted file in order to carry out a second opinion without delay. The second opinon your brother would be requesting would be to see if his current status of "Only palliative care treatment possible" could somehow be upgraded to something like "Tumor burden reduction/stabilization procedures are indeed possible with the intent to treat CRC as a chronic disease". I don't know the correct terminology to use, but there must be some way to say that your brother would like to explore the opportunities available for converting a passive "palliative" treatment situation into an active "treatment with an intent to improve" situation. He shouldn't have to be stigmatized as a "palliative care" patient when there might be some doctors somewhere who would see his situation otherwise and could propose an action plan to be followed.
Dear Jacques,
I wanted to express my sincere gratitude for your thoughtful and detailed advice on helping my brother with his second-opinion issue. I truly appreciate your care and concern, and I cannot thank you enough for your guidance.
Please understand that I am currently away from my brother, who does not speak English. As a result, I have been trying my best to understand his medical updates and share them with this wonderful community in English. The process has been challenging, as some information is quite difficult to comprehend.
Regarding my brother's second treatment cycle, Regarding my brother's second treatment cycle, he has remained hospitalised until now, and informed me that he generally feels well. However, he has lost his appetite for food and sometimes experiences abdominal discomfort after eating. He mentioned stopping his medications (Megamox 625, Zoron 8 mg, Nexium 20, Premosan, and Laxal). This coming Monday, he has an appointment with another doctor to discuss continuing his treatment.
I also wanted to update you regarding the "Baseline CEA," "MSI status," and "KRAS/NRAS/BRAF" tests you inquired about. My brother's current doctor is away from him, but they are scheduled to meet this Friday. I will encourage my brother to ask the doctor for updates on these test results so that we can better understand his situation.
As someone who has already provided valuable insights, I would like to ask you what additional information you would want if you were a doctor assessing my brother's case. So far, he has undergone a postcontrast enhanced CT scan of the chest, abdomen, and pelvis, an endoscopic sigmoid colon biopsy for pathological examination, and has started FOLFOX chemotherapy with Avastin. Any further guidance on what we should ask the doctor or look into would be greatly appreciated.
My family and I are doing our best to research and gather information on my brother's condition, but our knowledge is limited, as we only received this news in late February. I will try to update my signature once I have a better understanding of the situation.
Once again, thank you for your invaluable advice
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.